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Banik A, Knai C, Klepp KI, Rutter H, Rito A, Lien N, Baillergeau E, Szczuka Z, Boberska M, Kulis E, Luszczynska A. What policies are there and what policies are missing? A Photovoice study of adolescents' perspectives on obesity-prevention policies in their local environment. Obes Rev 2023; 24 Suppl 2:e13617. [PMID: 37753603 DOI: 10.1111/obr.13617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 06/15/2023] [Accepted: 07/13/2023] [Indexed: 09/28/2023]
Abstract
The aim of this study was to investigate adolescents' critical awareness of whether obesity prevention policies targeting physical activity (PA) and nutrition were operating in their local community. Participants were 41 adolescents (aged 16-18, 90% women) recruited from three communities in Poland. Prior to this study, they were involved in obesity-prevention participatory initiatives (conducted within the CO-CREATE project), where obesity-related public policy limitations were analyzed in a youth-led discussion. A Photovoice exercise was designed to capture obesity-related public policies that were either present or absent in young people's local environments. The photographs (N = 213) were coded and mapped according to the policy themes they illustrated, using the MOVING and NOURISHING frameworks. The public policies represented in the photographs are most frequently related to: healthy retail or food service environments; food advertising or promotion; structures and surroundings that promote PA; and infrastructure and opportunities that support public or active transport. Adolescents are critically aware of the presence and lack of specific public policies operating in their local environment, particularly policies affecting structural aspects of food and PA environments. Policy-oriented photovoice exercises may prompt critical awareness among adolescents and empower them to contribute to obesity prevention policy processes.
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Affiliation(s)
- Anna Banik
- CARE-BEH Center for Applied Research on Health Behavior and Health, SWPS University of Social Sciences and Humanities, Wroclaw, Poland
| | - Cecile Knai
- London School of Hygiene and Tropical Medicine, Faculty of Public Health and Policy, London, UK
| | - Knut-Inge Klepp
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
- Department of Nutrition, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Harry Rutter
- Department of Social and Policy Sciences, University of Bath, Bath, UK
| | - Ana Rito
- Centre for Studies and Research in Social Dynamics and Health - CEIDSS, Lisbon, Portugal
| | - Nanna Lien
- Department of Nutrition, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Evelyne Baillergeau
- Department of Sociology, University of Amsterdam, Amsterdam, The Netherlands
| | - Zofia Szczuka
- CARE-BEH Center for Applied Research on Health Behavior and Health, SWPS University of Social Sciences and Humanities, Wroclaw, Poland
| | - Monika Boberska
- CARE-BEH Center for Applied Research on Health Behavior and Health, SWPS University of Social Sciences and Humanities, Wroclaw, Poland
| | - Ewa Kulis
- CARE-BEH Center for Applied Research on Health Behavior and Health, SWPS University of Social Sciences and Humanities, Wroclaw, Poland
| | - Aleksandra Luszczynska
- CARE-BEH Center for Applied Research on Health Behavior and Health, SWPS University of Social Sciences and Humanities, Wroclaw, Poland
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Herstad SH, Grewal NK, Banik A, Klepp KI, Knai C, Luszczynska A, Mendes S, Rito A, Rutter H, Lien N. Adolescents' capacity to take action on obesity: A concurrent controlled before-and-after study of the European CO-CREATE project. Obes Rev 2023; 24 Suppl 2:e13622. [PMID: 37753601 DOI: 10.1111/obr.13622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 05/26/2023] [Accepted: 07/06/2023] [Indexed: 09/28/2023]
Abstract
This study evaluated the effect on reported readiness for action and attitudes toward obesity prevention among older adolescents (mean age 17) who took part in a youth-led participatory action research European initiative (CO-CREATE Youth Alliances) compared with a comparison group that acted as controls. This was a concurrent before-and-after controlled study across five countries and took place between September 2019 and October 2020. Adolescents (n = 159) recruited from schools and youth organizations came together with researchers and formed 15 Youth Alliances. An online questionnaire measuring their readiness for action and attitudes toward obesity prevention was administered. Alliance members (n = 62) who filled in the questionnaire at both baseline and postinitiative, and adolescents from the comparison group (n = 132) who completed the questionnaire twice were included in the main analysis. Two-level linear mixed models controlling for country-related variance were fitted. Alliance members scored significantly higher than the comparison group on two factors in each of the readiness for action, responsibility, and drivers of behavior concepts. The findings suggest that involving youth in co-creating policies to prevent obesity may increase adolescents' readiness for action and promote a shift in adolescents' conceptualization of obesity from an individual perspective to a societal responsibility and drivers of behavior.
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Affiliation(s)
| | | | - Anna Banik
- SWPS University of Social Sciences and Humanities, Wroclaw, Poland
| | - Knut-Inge Klepp
- Department of Nutrition, University of Oslo, Oslo, Norway
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Cecile Knai
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Sofia Mendes
- Center for Studies and Research on Social Dynamics and Health - CEIDSS, Lisbon, Portugal
| | - Ana Rito
- National Institute of Health Dr. Ricardo Jorge, Lisbon, Portugal
| | - Harry Rutter
- Department of Social and Policy Sciences, University of Bath, Bath, UK
| | - Nanna Lien
- Department of Nutrition, University of Oslo, Oslo, Norway
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Samdal O, Budin-Ljøsne I, Haug E, Helland T, Kjostarova-Unkovska L, Bouillon C, Bröer C, Corell M, Cosma A, Currie D, Eriksson C, Felder-Puig R, Gaspar T, Hagquist C, Harbron J, Jåstad A, Kelly C, Knai C, Kleszczewska D, Kysnes BB, Lien N, Luszczynska A, Moerman G, Moreno-Maldonado C, NicGabhainn S, Pudule I, Rakic JG, Rito A, Rønnestad AM, Ulstein M, Rutter H, Klepp KI. Encouraging greater empowerment for adolescents in consent procedures in social science research and policy projects. Obes Rev 2023; 24 Suppl 2:e13636. [PMID: 37753605 DOI: 10.1111/obr.13636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 07/23/2023] [Accepted: 07/25/2023] [Indexed: 09/28/2023]
Abstract
The United Nations Convention on the Rights of the Child emphasizes the importance of allowing children and adolescents to influence decisions that are important to them following their age and maturity. This paper explores the principles, practices, and implications around using parental versus child/adolescent consent when participating in social science research and policy development. Experiences from two studies are presented: The Confronting Obesity: Co-creating policy with youth (CO-CREATE) and the Health Behaviour in School-aged Children (HBSC) study, a World Health Organization (WHO) Collaborative Cross-National study. Although parental consent may be an important gatekeeper for protecting children and adolescents from potentially harmful research participation, it may also be considered an obstacle to the empowerment of children and adolescents in case they want to share their views and experiences directly. This paper argues that evaluation of possible harm should be left to ethics committees and that, if no harm related to the research participation processes is identified and the project has a clear perspective on collaborating with the target group, adolescents from the age of 12 years should be granted the legal capacity to give consent to participate in the research project. Collaboration with adolescents in the development of the research project is encouraged.
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Affiliation(s)
- Oddrun Samdal
- Department of Health Promotion and Development, University of Bergen, Bergen, Norway
| | - Isabelle Budin-Ljøsne
- Department of Food Safety, Division of Climate and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Ellen Haug
- Department of Health Promotion and Development, University of Bergen, Bergen, Norway
| | - Trond Helland
- Department of Health Promotion and Development, University of Bergen, Bergen, Norway
| | | | | | - Christian Bröer
- Department of Sociology, University of Amsterdam, Amsterdam, The Netherlands
| | - Maria Corell
- Unit for Mental Health, Children and Youth, Public Health Agency of Sweden, Stockholm, Sweden
| | - Alina Cosma
- Department of Sociology, Trinity College Dublin, Dublin, Ireland
| | - Dorothy Currie
- School of Medicine, St. Andrews University, St. Andrews, UK
| | - Charli Eriksson
- Department of Learning, Informatics, Management and Ethics, Karolinska Institute, Solna, Sweden
| | - Rosemarie Felder-Puig
- Department of Evidence and Quality Standards, Austrian National Public Health Institute, Vienna, Austria
| | - Tania Gaspar
- Psychology and health Sciences Department, Lusofona University, Lisbon, Portugal
| | - Curt Hagquist
- Department of Education and Special Education, University of Gothenburg, Gothenburg, Sweden
| | - Janetta Harbron
- Research Centre for Health Through Physical Activity, Lifestyle and Sport (HPALS), Department of Human Biology, University of Cape Town, Cape Town, South Africa
| | - Atle Jåstad
- Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Colette Kelly
- Health Promotion Research Centre, University of Galway, Galway, Ireland
| | - Cecile Knai
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Dorota Kleszczewska
- Department of Child and Adolescent Health, Institute of Mother and Child, Warsaw, Poland
| | | | - Nanna Lien
- Department of Nutrition, University of Oslo, Oslo, Norway
| | | | - Gerben Moerman
- Department of Sociology, University of Amsterdam, Amsterdam, The Netherlands
| | | | | | - Iveta Pudule
- Centre for Disease Prevention and Control, Riga, Latvia
| | - Jelena Gudelj Rakic
- Centre of Health Promotion, Institute of Public Health of Serbia, Beograd, Serbia
| | - Ana Rito
- Centre for Studies and Research in Social Dynamics and Health, Lisbon, Portugal
| | | | | | - Harry Rutter
- Department of Social and Policy Sciences, University of Bath, Bath, UK
| | - Knut-Inge Klepp
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
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Klepp KI, Helleve A, Brinsden H, Bröer C, Budin-Ljøsne I, Harbron J, Knai C, Lien N, Luszczynska A, Nesrallah S, Oldridge-Turner K, Rito A, Samdal O, Savona N, Stensdal MK, Allender S, Hoelscher DM, Rutter H. Overweight and obesity prevention for and with adolescents: The "Confronting obesity: Co-creating policy with youth" (CO-CREATE) project. Obes Rev 2023; 24 Suppl 1:e13540. [PMID: 36623268 DOI: 10.1111/obr.13540] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 09/11/2022] [Accepted: 09/27/2022] [Indexed: 01/11/2023]
Abstract
The CO-CREATE project focuses on the need for research on obesity prevention in adolescents to move away from studies of single interventions, toward the investigation of systems-based research incorporating youth involvement. This paper provides an overview of the project, presenting the objectives, design, and novel methodologies applied, as well as findings to date and anticipated outcomes. Adolescents (16-18 years old) in five European countries participated. Methods applied in the project include monitoring and benchmarking of policies, systematic literature reviews, epidemiological surveillance, linking observed overweight and obesity trends to observed policy landscapes, group model building to identify perceived drivers of obesity, alliance building with adolescents, dialog with stakeholders, and system dynamics modelling to explore the potential impact of policy options. Outcomes include tools for developing policy ideas and investigation of prevention strategies with adolescents, including policy databases, system maps of drivers of obesity, protocols for organizing youth alliances, an intergenerational policy dialog tool, and system dynamic models exploring the impacts of cocreated policy ideas. These outcomes make an important contribution to building a pan-European infrastructure for designing and evaluating policies and for providing youth with the opportunity to make their voices heard in the development and implementation of obesity prevention measures.
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Affiliation(s)
- Knut-Inge Klepp
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway.,Department of Nutrition, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Arnfinn Helleve
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
| | | | - Christian Bröer
- Department of Sociology, University of Amsterdam, Amsterdam, The Netherlands
| | - Isabelle Budin-Ljøsne
- Department of Food Safety, Division of Climate and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Janetta Harbron
- Division of Physiological Sciences, Health through Physical Activity, Lifestyle & Sport (HPALS) Research Centre, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Cecile Knai
- Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Nanna Lien
- Department of Nutrition, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Aleksandra Luszczynska
- CARE-BEH Center for Applied Research on Health Behavior and Health, SWPS University of Social Sciences and Humanities, Wroclaw, Poland
| | | | | | - Ana Rito
- Centre for Studies and Research on Social Dynamics and Health-CEIDSS, Lisbon, Lisbon, Portugal
| | - Oddrun Samdal
- Department of Health Promotion and Development, Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Natalie Savona
- Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Steven Allender
- Global Obesity Centre, Institute for Health Transformation, Deakin University, Melbourne, Australia
| | - Deanna M Hoelscher
- School of Public Health Austin Campus, University of Texas Health Science Center at Houston (UTHealth), Austin, Texas, USA
| | - Harry Rutter
- Department of Social and Policy Sciences, University of Bath, Bath, UK
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Budin-Ljøsne I, Ayuandini S, Baillergeau E, Bröer C, Helleve A, Klepp KI, Kysnes B, Lien N, Luszczynska A, Nesrallah S, Rito A, Rutter H, Samdal O, Savona N, Veltkamp G. Ethical considerations in engaging young people in European obesity prevention research: The CO-CREATE experience. Obes Rev 2023; 24 Suppl 1:e13518. [PMID: 36416177 DOI: 10.1111/obr.13518] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 09/05/2022] [Accepted: 10/04/2022] [Indexed: 11/23/2022]
Abstract
Engaging youth in obesity prevention research and policy action is essential to develop strategies that are relevant and sensitive to their needs. Research with young people requires critical reflection to safeguard their rights, dignity, and well-being. The CO-CREATE project used various methods to engage approximately 300 European youth aged 15-19 years in the development of policies to prevent adolescent obesity. This paper discusses ethical considerations made in the project pertaining to the youth's voluntary participation, their protection from obesity stigma, respect for their time, data privacy and confidentiality, power balance, and equality of opportunity to participate in the research. We describe measures implemented to prevent or limit the emergence of ethical challenges in our interaction with youth and discuss their relevance based on our experience with implementation. While some challenges seemingly were prevented, others arose related to the youth's voluntary participation, time burdens on them, and the sustainability of participation under the Covid-19 pandemic. Concrete and ongoing ethical guidance may be useful in projects aiming to interact and build collaborative relationships with youth for long periods of time.
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Affiliation(s)
| | - Sherria Ayuandini
- Department of Sociology, University of Amsterdam, Amsterdam, The Netherlands
| | - Evelyne Baillergeau
- Department of Sociology, University of Amsterdam, Amsterdam, The Netherlands
| | - Christian Bröer
- Department of Sociology, University of Amsterdam, Amsterdam, The Netherlands
| | - Arnfinn Helleve
- Centre for Evaluation of Public Health Measures, Norwegian Institute of Public Health, Oslo, Norway
| | - Knut-Inge Klepp
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway.,Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Bjarte Kysnes
- Department of Health Promotion and Development, University of Bergen, Bergen, Norway
| | - Nanna Lien
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Aleksandra Luszczynska
- Wroclaw Faculty of Psychology, SWPS University of Social Sciences and Humanities, Wroclaw, Poland
| | | | | | - Harry Rutter
- Department of Social and Policy Sciences, University of Bath, Bath, UK
| | - Oddrun Samdal
- Department of Health Promotion and Development, University of Bergen, Bergen, Norway
| | - Natalie Savona
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Gerlieke Veltkamp
- Department of Sociology, University of Amsterdam, Amsterdam, The Netherlands
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Hassapidou M, Duncanson K, Shrewsbury V, Ells L, Mulrooney H, Androutsos O, Vlassopoulos A, Rito A, Farpourt N, Brown T, Douglas P, Ramos Sallas X, Woodward E, Collins C. EASO and EFAD Position Statement on Medical Nutrition Therapy for the Management of Overweight and Obesity in Children and Adolescents. Obes Facts 2023; 16:29-52. [PMID: 36349767 PMCID: PMC9890183 DOI: 10.1159/000527540] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 09/21/2022] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION This position statement on medical nutrition therapy in the management of overweight or obesity in children and adolescents was prepared by an expert committee convened by the European Association for the Study of Obesity (EASO) and developed in collaboration with the European Federation of the Associations of Dietitians (EFAD). METHODS It is based on the best evidence available from systematic reviews of randomized controlled trials on child and adolescent overweight and obesity treatment and other relevant peer-reviewed literature. RESULTS Multicomponent behavioural interventions are generally considered to be the gold standard treatment for children and adolescents living with obesity. The evidence presented in this position statement confirms that dietary interventions can effectively improve adiposity-related outcomes. Dietary strategies should focus on the reduction of total energy intake through promotion of food-based guidelines that target modification of usual eating patterns and behaviours. These should target increasing intakes of nutrient-rich foods with a lower energy density, specifically vegetables and fruits, and a reduction in intakes of energy-dense nutrient-poor foods and beverages. In addition, higher intensity, longer duration treatments, delivered by interventionists with specialized dietetic-related skills and co-designed with families, are associated with greater treatment effects. DISCUSSION Such interventions should be resourced adequately so that they can be implemented in a range of settings and in different formats, including digital or online delivery, to enhance accessibility.
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Affiliation(s)
- Maria Hassapidou
- Department of Nutritional Sciences & Dietetics, International Hellenic University, Thessaloniki, Greece
- ESDN Obesity, European Federation of the Associations of Dieticians, Naarden, The Netherlands
| | - Kerith Duncanson
- School of Medicine and Public Health, The University of Newcastle Australia, Callaghan, New South Wales, Australia
| | - Vanessa Shrewsbury
- School of Health Sciences, College of Health, Medicine and Wellbeing, The University of Newcastle Australia, Callaghan, New South Wales, Australia
| | - Louisa Ells
- Obesity Institute, School of Health, Leeds Beckett University, Leeds, UK
| | - Hilda Mulrooney
- ESDN Obesity, European Federation of the Associations of Dieticians, Naarden, The Netherlands
- Department of Life Sciences, Pharmacy and Chemistry, SEC Faculty, Kingston University London, Kingston upon Thames, UK
| | - Odysseas Androutsos
- ESDN Obesity, European Federation of the Associations of Dieticians, Naarden, The Netherlands
- Department of Nutrition-Dietetics, University of Thessaly, Trikala, Greece
| | - Antonis Vlassopoulos
- ESDN Obesity, European Federation of the Associations of Dieticians, Naarden, The Netherlands
- Department of Food Science & Human Nutrition, Agricultural University of Athens, Athens, Greece
- *Maria Hassapidou,
| | - Ana Rito
- National Institute of Health Ricardo Jorge I.P., Lisbon, Portugal
| | - Nathalie Farpourt
- Obesity Prevention and Care Program Contrepoids, Service of Endocrinology, Diabetology and Therapeutic Education, Department of Medicine, University Hospitals of Geneva and University of Geneva, Geneva, Switzerland
| | - Tamara Brown
- Applied Obesity Research Centre in the School of Health, Leeds Beckett University, Leeds, UK
| | - Pauline Douglas
- Nutrition Innovation Center for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, UK
| | | | - Euan Woodward
- European Association for the Study of Obesity, Teddington, UK
| | - Clare Collins
- School of Health Sciences, College of Health, Medicine and Wellbeing, The University of Newcastle Australia, Callaghan, New South Wales, Australia
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Goiana-da-Silva F, Cruz-e-Silva D, Rito A, Lopes C, Muc M, Darzi A, Araújo F, Miraldo M, Morais Nunes A, Allen LN. Modeling the health impact of legislation to limit the salt content of bread in Portugal: A macro simulation study. Front Public Health 2022; 10:876827. [PMID: 36176524 PMCID: PMC9513608 DOI: 10.3389/fpubh.2022.876827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 07/20/2022] [Indexed: 01/21/2023] Open
Abstract
Background Excessive salt consumption-associated with a range of adverse health outcomes-is very high in Portugal, and bread is the second largest source. Current Portuguese legislation sets a maximum limit of 1.4 g salt per 100 g bread, but imported and traditional breads are exempted. In 2017 the Ministry of Health proposed reducing the salt threshold to 1.0/100 g by 2022, however the legislation was vetoed by the European Commission on free-trade grounds. Aims To estimate the health impact of subjecting imported and traditional breads to the current 1.4 g threshold, and to model the potential health impact of implementing the proposed 1.0 g threshold. Methods We gathered bread sales, salt consumption, and epidemiological data from robust publicly available data sources. We used the open source WHO PRIME modeling tool to estimate the number of salt-related deaths that would have been averted in 2016 (the latest year for which all data were available) from; (1) Extending the 1.4 g threshold to all types of bread, and (2) Applying the 1.0 g threshold to all bread sold in Portugal. We used Monte Carlo simulations to generate confidence intervals. Results Applying the current 1.4 g threshold to imported and traditional bread would have averted 107 deaths in 2016 (95% CI: 43-172). Lowering the current threshold from 1.4 to 1.0 g and applying it to all bread products would reduce daily salt consumption by 3.6 tons per day, saving an estimated 286 lives a year (95% CI: 123-454). Conclusions Salt is an important risk factor in Portugal and bread is a major source. Lowering maximum permissible levels and removing exemptions would save lives. The European Commission should revisit its decision on the basis of this new evidence.
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Affiliation(s)
- Francisco Goiana-da-Silva
- Centre for Health Policy, Institute of Global Health Innovation, Imperial College London, London, United Kingdom,Faculdade de Ciências da Saúde, Universidade da Beira Interior, Covilhã, Portugal
| | - David Cruz-e-Silva
- Center for Innovation, Technology and Policy Research, IN+, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
| | - Ana Rito
- National Institute of Health, Porto, Portugal
| | - Carla Lopes
- Department of Public Health and Forensic Sciences, and Medical Education, University of Porto Medical School, Porto, Portugal,Epidemiology Research Unit, Institute of Public Health, University of Porto, Porto, Portugal
| | - Magdalena Muc
- Appetite and Obesity Research Group, Department of Psychological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Ara Darzi
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Fernando Araújo
- Centro Hospitalar Universitário São João, Faculty of Medicine, Porto University, Porto, Portugal
| | - Marisa Miraldo
- Department of Management, Centre for Health Economics and Policy Innovation, Imperial College Business School, London, United Kingdom
| | - Alexandre Morais Nunes
- Centro de Administração e Políticas Públicas, Instituto Superior de Ciências Sociais e Políticas, Universidade de Lisboa, Lisboa, Portugal
| | - Luke N. Allen
- London School of Hygiene and Tropical Medicine, London, United Kingdom,*Correspondence: Luke N. Allen
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Ramos Salas X, Buoncristiano M, Williams J, Kebbe M, Spinelli A, Nardone P, Rito A, Duleva V, Musić Milanović S, Kunesova M, Braunerová RT, Hejgaard T, Rasmussen M, Shengelia L, Abdrakhmanova S, Abildina A, Usuopva Z, Hyska J, Burazeri G, Petrauskiene A, Pudule I, Sant'Angelo VF, Kujundzic E, Fijałkowska A, Cucu A, Brinduse LA, Peterkova V, Bogova E, Gualtieri A, Solano MG, Gutiérrez-González E, Rakhmatullaeva S, Tanrygulyyeva M, Yardim N, Weghuber D, Mäki P, Russell Jonsson K, Starc G, Juliusson PB, Heinen MM, Kelleher C, Ostojic S, Popovic S, Kovacs VA, Akhmedova D, Farpour-Lambert NJ, Rutter H, Li B, Boymatova K, Rakovac I, Wickramasinghe K, Breda J. Parental Perceptions of Children's Weight Status in 22 Countries: The WHO European Childhood Obesity Surveillance Initiative: COSI 2015/2017. Obes Facts 2021; 14:658-674. [PMID: 34818257 PMCID: PMC8739931 DOI: 10.1159/000517586] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 05/28/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Parents can act as important agents of change and support for healthy childhood growth and development. Studies have found that parents may not be able to accurately perceive their child's weight status. The purpose of this study was to measure parental perceptions of their child's weight status and to identify predictors of potential parental misperceptions. METHODS We used data from the World Health Organization (WHO) European Childhood Obesity Surveillance Initiative and 22 countries. Parents were asked to identify their perceptions of their children's weight status as "underweight," "normal weight," "a little overweight," or "extremely overweight." We categorized children's (6-9 years; n = 124,296) body mass index (BMI) as BMI-for-age Z-scores based on the 2007 WHO-recommended growth references. For each country included in the analysis and pooled estimates (country level), we calculated the distribution of children according to the WHO weight status classification, distribution by parental perception of child's weight status, percentages of accurate, overestimating, or underestimating perceptions, misclassification levels, and predictors of parental misperceptions using a multilevel logistic regression analysis that included only children with overweight (including obesity). Statistical analyses were performed using Stata version 15 1. RESULTS Overall, 64.1% of parents categorized their child's weight status accurately relative to the WHO growth charts. However, parents were more likely to underestimate their child's weight if the child had overweight (82.3%) or obesity (93.8%). Parents were more likely to underestimate their child's weight if the child was male (adjusted OR [adjOR]: 1.41; 95% confidence intervals [CI]: 1.28-1.55); the parent had a lower educational level (adjOR: 1.41; 95% CI: 1.26-1.57); the father was asked rather than the mother (adjOR: 1.14; 95% CI: 0.98-1.33); and the family lived in a rural area (adjOR: 1.10; 95% CI: 0.99-1.24). Overall, parents' BMI was not strongly associated with the underestimation of children's weight status, but there was a stronger association in some countries. DISCUSSION/CONCLUSION Our study supplements the current literature on factors that influence parental perceptions of their child's weight status. Public health interventions aimed at promoting healthy childhood growth and development should consider parents' knowledge and perceptions, as well as the sociocultural contexts in which children and families live.
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Affiliation(s)
- Ximena Ramos Salas
- WHO European Office for Prevention and Control of NCDs, Country Health Programmes, WHO Regional Office for Europe, Copenhagen, Denmark
- European Association for the Study of Obesity, Teddington, United Kingdom
| | | | - Julianne Williams
- European Association for the Study of Obesity, Teddington, United Kingdom
| | - Maryam Kebbe
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | | | | | - Ana Rito
- National Institute of Health Dr. Ricardo Jorge I.P., Lisbon, Portugal
| | - Vesselka Duleva
- National Center of Public Health and Analyses, Ministry of Health, Sofia, Bulgaria
| | - Sanja Musić Milanović
- University of Zagreb, School of Medicine/Croatian Institute of Public Health, Zagreb, Croatia
| | - Marie Kunesova
- Obesity Management Centre, Institute of Endocrinology, Prague, Czechia
| | | | | | - Mette Rasmussen
- National Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Lela Shengelia
- National Center for Disease Control and Public Health of Georgia, Tbilisi, Georgia
| | - Shynar Abdrakhmanova
- National Center of Public Health of the Ministry of Health of the Republic of Kazakhstan, Nur-Sultan, Kazakhstan
| | - Akbota Abildina
- National Center of Public Health of the Ministry of Health of the Republic of Kazakhstan, Nur-Sultan, Kazakhstan
| | | | | | | | - Aušra Petrauskiene
- Department of Preventive Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Iveta Pudule
- Centre for Disease Prevention and Control, Riga, Latvia
| | | | | | - Anna Fijałkowska
- Department of Cardiology, Institute of Mother and Child, Warsaw, Poland
| | - Alexandra Cucu
- Department of Public Health and Management, University of Medicine and Pharmacy Carol Davila Romania, Bucharest, Romania
| | - Lacramioara Aurelia Brinduse
- Department of Public Health and Management, University of Medicine and Pharmacy Carol Davila Romania, Bucharest, Romania
| | - Valentina Peterkova
- Institute of Pediatric Endocrinology, Endocrine Research Centre, Moscow, Russian Federation
| | - Elena Bogova
- Institute of Pediatric Endocrinology, Endocrine Research Centre, Moscow, Russian Federation
| | | | - Marta García Solano
- Observatory of Nutrition and Study of Obesity, Spanish Agency for Food Safety & Nutrition, Ministry of Health, Madrid, Spain
| | - Enrique Gutiérrez-González
- Observatory of Nutrition and Study of Obesity, Spanish Agency for Food Safety & Nutrition, Ministry of Health, Madrid, Spain
| | - Sanavbar Rakhmatullaeva
- Department for Organization of Health Services to Children, Mothers, Adolescents and Family Planning, Ministry of Health and Social Protection of the Population, Dushanbe, Tajikistan
| | - Maya Tanrygulyyeva
- Internal Diseases Department of the Scientific Clinical Centre of Mother and Child Health, Ashgabat, Turkmenistan
| | - Nazan Yardim
- Ministry of Health, Public Health General Directorate, Ankara, Turkey
| | - Daniel Weghuber
- WHO European Office for Prevention and Control of NCDs, Country Health Programmes, WHO Regional Office for Europe, Copenhagen, Denmark
| | - Päivi Mäki
- European Association for the Study of Obesity, Teddington, United Kingdom
| | | | | | | | - Mirjam M. Heinen
- National Center of Public Health and Analyses, Ministry of Health, Sofia, Bulgaria
| | - Cecily Kelleher
- National Center of Public Health and Analyses, Ministry of Health, Sofia, Bulgaria
| | - Sergej Ostojic
- University of Zagreb, School of Medicine/Croatian Institute of Public Health, Zagreb, Croatia
| | - Stevo Popovic
- Obesity Management Centre, Institute of Endocrinology, Prague, Czechia
| | | | - Dilorom Akhmedova
- National Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | | | - Harry Rutter
- National Center of Public Health of the Ministry of Health of the Republic of Kazakhstan, Nur-Sultan, Kazakhstan
| | - Bai Li
- Centre for Health Promotion, Bishkek, Kyrgyzstan
| | | | - Ivo Rakovac
- European Association for the Study of Obesity, Teddington, United Kingdom
| | - Kremlin Wickramasinghe
- Department of Preventive Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Joao Breda
- European Association for the Study of Obesity, Teddington, United Kingdom
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Santos M, Matias F, Vaz R, Castanheira I, Rito A, Loureiro I, Assunção R. A study of commercially available complementary foods for infants and young children under 36 months. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab165.152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Commercially available complementary foods (CACFs) have been assuming an important proportion of infants and toddlers' diets in high-income countries, despite the concerns regarding their nutritional content and potential problematic marketing strategies used to promote these products. In 2016, the WHO guidance on ending the inappropriate promotion of foods for infants and young children (IYC) was approved (1) to support countries to take action on this issue. To implement this Guidance, a draft Nutrient Profile Model (NPM) (2) was developed to drive decisions regarding the identification of foods which are inappropriate for promotion.
Aim
To support the implementation of the NPM at National Level, studying the availability, composition, and marketing of CACFs for IYC in Portugal.
Methods
Three phases were considered: 1) collect data on CACFs products targeted at IYC (0-36 months); 2) compare composition of these products with WHO guidance; 3) compare methods used to promote these products with WHO Guidance.
Results
A total of 209 products were sampled. The most common products were soft-wet spoonable, ready-to-eat foods (n = 129), dry, powdered and instant cereal/starchy foods (n = 61) and dry finger foods and snacks (n = 16). Twenty-five products (11%) were marketed as being suitable for infants under the age of 6 months. For infants between 6-8 months 78% of the products were marketed as being suitable. For the age group 12 months and over, 11% of the products were marketed as being suitable.
Conclusions
This study provides valuable insights into the CACFs at the national level and reinforces that action is needed to improve the implementation and operationalization of WHO guidance on ending the inappropriate promotion of foods for IYC.
Key messages
NPM can support countries identifying products that can/cannot be promoted for IYC. It is a key opportunity to build policy measures, ensuring children healthy growth and development.
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Affiliation(s)
- M Santos
- Food and Nutrition Department, National Health Institute Dr Ricardo Jorge, Lisbon, Portugal
- NOVA National School of Public Health, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - F Matias
- Food and Nutrition Department, National Health Institute Dr Ricardo Jorge, Lisbon, Portugal
| | - R Vaz
- Food and Nutrition Department, National Health Institute Dr Ricardo Jorge, Lisbon, Portugal
| | - I Castanheira
- Food and Nutrition Department, National Health Institute Dr Ricardo Jorge, Lisbon, Portugal
| | - A Rito
- Food and Nutrition Department, National Health Institute Dr Ricardo Jorge, Lisbon, Portugal
| | - I Loureiro
- NOVA National School of Public Health, Public Health Research Center, Comprehensive Health Research Center, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - R Assunção
- Food and Nutrition Department, National Health Institute Dr Ricardo Jorge, Lisbon, Portugal
- CESAM, Centre for Environmental and Marine Studies, University of Aveiro, Aveiro, Portugal
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SR, Zamani F, Zambon S, Zampelas A, Zamrazilová H, Zapata ME, Zargar AH, Ko Zaw K, Zdrojewski T, Zejglicova K, Vrkic TZ, Zeng Y, Zhang L, Zhang ZY, Zhao D, Zhao MH, Zhao W, Zhen S, Zheng W, Zheng Y, Zholdin B, Zhou M, Zhu D, Zins M, Zitt E, Zocalo Y, Cisneros JZ, Zuziak M, Ezzati M, Filippi S. Heterogeneous contributions of change in population distribution of body mass index to change in obesity and underweight. eLife 2021; 10:e60060. [PMID: 33685583 PMCID: PMC7943191 DOI: 10.7554/elife.60060] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 01/07/2021] [Indexed: 02/05/2023] Open
Abstract
From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesity increased, in most regions, with significant variation in the magnitude of these changes across regions. We investigated how much change in mean body mass index (BMI) explains changes in the prevalence of underweight, obesity, and severe obesity in different regions using data from 2896 population-based studies with 187 million participants. Changes in the prevalence of underweight and total obesity, and to a lesser extent severe obesity, are largely driven by shifts in the distribution of BMI, with smaller contributions from changes in the shape of the distribution. In East and Southeast Asia and sub-Saharan Africa, the underweight tail of the BMI distribution was left behind as the distribution shifted. There is a need for policies that address all forms of malnutrition by making healthy foods accessible and affordable, while restricting unhealthy foods through fiscal and regulatory restrictions.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Nayu Ikeda
- National Institutes of Biomedical Innovation, Health and Nutrition
| | | | | | | | - Jing Liu
- Capital Medical University Beijing An Zhen Hospital
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Shoaib Afzal
- University of Copenhagen
- Copenhagen University Hospital
| | | | | | | | | | | | | | - Ali Ahmadi
- Shahrekord University of Medical Sciences
| | | | | | | | | | - Kamel Ajlouni
- National Center for Diabetes, Endocrinology and Genetics
| | | | | | | | | | | | | | | | | | | | | | | | - Eman Aly
- World Health Organization Regional Office for the Eastern Mediterranean
| | | | - Parisa Amiri
- Research Center for Social Determinants of Health
| | | | | | | | | | | | | | | | | | - Joana Araújo
- Institute of Public Health of the University of Porto
| | | | | | | | | | | | | | | | | | | | | | | | - Shina Avi
- Tel-Aviv University
- Hebrew University of Jerusalem
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Abdul Basit
- Baqai Institute of Diabetology and Endocrinology
| | | | | | | | | | | | | | | | | | | | | | | | - Judith Benedics
- Federal Ministry of Social Affairs, Health, Care and Consumer Protection
| | | | | | | | | | | | | | | | | | | | | | | | - Hongsheng Bi
- Shandong University of Traditional Chinese Medicine
| | - Yufang Bi
- Shanghai Jiao-Tong University School of Medicine
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - João Breda
- World Health Organization Regional Office for Europe
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- Council for Agricultural Research and Economics
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Angela Chetrit
- The Gertner Institute for Epidemiology and Health Policy Research
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- Canadian Fitness and Lifestyle Research Institute
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Rachel Dankner
- The Gertner Institute for Epidemiology and Health Policy Research
| | | | | | | | - Luc Dauchet
- University of Lille
- Lille University Hospital
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- Beijing Center for Disease Prevention and Control
| | | | | | | | | | | | | | - Anar Dushpanova
- Scuola Superiore Sant'Anna
- Al-Farabi Kazakh National University
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Günther Fink
- Swiss Tropical and Public Health Institute
- University of Basel
| | | | | | | | - Heba M Fouad
- World Health Organization Regional Office for the Eastern Mediterranean
| | | | | | | | | | | | | | | | | | | | | | | | - Mihai Gafencu
- Victor Babes University of Medicine and Pharmacy Timisoara
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Marcel Goldberg
- Institut National de la Santé et de la Recherche Médicale
- Paris University
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Yin Guo
- Capital Medical University Beijing Tongren Hospital
| | | | - Rajeev Gupta
- Eternal Heart Care Centre and Research Institute
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- Beijing Institute of Ophthalmology
| | | | | | | | | | | | | | - Yuan He
- National Research Institute for Health and Family Planning
| | - Yuna He
- Chinese Center for Disease Control and Prevention
| | | | | | | | | | | | - Ana Henriques
- Institute of Public Health of the University of Porto
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- Institute of Molecular and Clinical Ophthalmology Basel
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- French National Research Institute for Sustainable Development
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- Johns Hopkins Bloomberg School of Public Health
| | | | | | | | | | | | | | | | | | - Roya Kelishadi
- Research Institute for Primordial Prevention of Non-communicable Disease
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- PASs Hirszfeld Institute of Immunology and Experimental Therapy
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- French National Research Institute for Sustainable Development
| | - Vera Lanska
- Institute for Clinical and Experimental Medicine
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- University of Chinese Academy of Sciences
| | | | | | | | | | | | - Lijuan Liu
- Capital Medical University Beijing Tongren Hospital
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- National Research Institute for Health and Family Planning
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- Institute of Neuroscience of the National Research Council
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- French National Research Institute for Sustainable Development
| | | | | | - Päivi Mäki
- Finnish Institute for Health and Welfare
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Jaume Marrugat
- CIBERCV
- Institut Hospital del Mar d'Investigacions Mèdiques
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- Capital Institute of Pediatrics
| | | | | | | | | | | | | | - GK Mini
- Women’s Social and Health Studies Foundation
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- University of Strasbourg
- Strasbourg University Hospital
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Jorge Motta
- Instituto Conmemorativo Gorgas de Estudios de la Salud
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Jana Námešná
- Banska Bystrica Regional Authority of Public Health
| | | | | | | | | | | | | | | | | | | | - Keiu Nelis
- National Institute for Health Development
| | - Liis Nelis
- National Institute for Health Development
| | | | | | | | | | | | | | | | - Yury P Nikitin
- SB RAS Federal Research Center Institute of Cytology and Genetics
| | - Guang Ning
- Shanghai Jiao-Tong University School of Medicine
| | | | | | - Marianna Noale
- Institute of Neuroscience of the National Research Council
| | | | | | | | | | | | | | | | | | | | - Eha Nurk
- National Institute for Health Development
| | | | | | | | | | | | | | - Kyungwon Oh
- Korea Centers for Disease Control and Prevention
| | | | - Claes Ohlsson
- University of Gothenburg
- Sahlgrenska University Hospital
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Domenico Palli
- Institute for Cancer Research, Prevention and Clinical Network
| | | | | | | | | | | | - Francesco Panza
- IRCCS Ente Ospedaliero Specializzato in Gastroenterologia S. de Bellis
| | | | | | - Suyeon Park
- Korea Centers for Disease Control and Prevention
| | | | | | - Ionela M Pascanu
- University of Medicine, Pharmacy, Science and Technology of Târgu Mures
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Iris Pigeot
- Leibniz Institute for Prevention Research and Epidemiology - BIPS
| | | | | | | | | | | | | | | | | | | | | | - Raluca M Pop
- University of Medicine, Pharmacy, Science and Technology of Târgu Mures
| | | | - Miquel Porta
- Institut Hospital del Mar d'Investigacions Mèdiques
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Maria Puiu
- Victor Babes University of Medicine and Pharmacy Timisoara
| | | | | | | | | | | | | | | | | | | | | | - Manu Raj
- Amrita Institute of Medical Sciences
| | | | | | - Ivo Rakovac
- World Health Organization Regional Office for Europe
| | | | | | | | | | - Rafel Ramos
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Ana Rito
- National Institute of Health Doutor Ricardo Jorge
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Paola Russo
- Institute of Food Sciences of the National Research Council
| | | | | | | | | | | | | | | | | | - Nader Saki
- Ahvaz Jundishapur University of Medical Sciences
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Savvas Savva
- Research and Education Institute of Child Health
| | - Mathilde Savy
- French National Research Institute for Sustainable Development
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Aletta E Schutte
- University of New South Wales
- The George Institute for Global Health
| | | | | | | | - Abhijit Sen
- Center for Oral Health Services and Research Mid-Norway
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Alfonso Siani
- Institute of Food Sciences of the National Research Council
| | | | | | | | | | | | | | | | | | | | | | | | | | - Liam Smeeth
- London School of Hygiene & Tropical Medicine
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Igor Spiroski
- Institute of Public Health
- Ss. Cyril and Methodius University
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Lela Sturua
- National Center for Disease Control and Public Health
| | | | | | | | | | | | | | | | | | | | | | | | | | - Lucjan Szponar
- National Institute of Public Health – National Institute of Hygiene
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Pierre Traissac
- French National Research Institute for Sustainable Development
| | | | | | | | - Oanh TH Trinh
- University of Medicine and Pharmacy at Ho Chi Minh City
| | | | | | | | | | | | | | | | | | | | | | - Gilad Twig
- Tel-Aviv University
- Hebrew University of Jerusalem
| | | | | | | | | | - Eunice Ugel
- Universidad Centro-Occidental Lisandro Alvarado
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Anette Varbo
- Copenhagen University Hospital
- University of Copenhagen
| | | | | | | | - Tomas Vega
- Consejería de Sanidad Junta de Castilla y León
| | | | | | | | | | | | | | | | - Lucie Viet
- National Institute for Public Health and the Environment
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Ningli Wang
- Capital Medical University Beijing Tongren Hospital
| | | | | | | | | | | | | | - Adelheid Weber
- Federal Ministry of Social Affairs, Health, Care and Consumer Protection
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Bogdan Wojtyniak
- National Institute of Public Health - National Institute of Hygiene
| | | | | | | | | | - Jean Woo
- The Chinese University of Hong Kong
| | | | | | - Jianfeng Wu
- Shandong University of Traditional Chinese Medicine
| | | | | | - Haiquan Xu
- Institute of Food and Nutrition Development of Ministry of Agriculture and Rural Affairs
| | - Liang Xu
- Beijing Institute of Ophthalmology
| | | | | | - Weili Yan
- Children's Hospital of Fudan University
| | | | | | - Yang Yang
- Shanghai Educational Development Co. Ltd
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- Peking University
- Duke University
| | | | | | - Dong Zhao
- Capital Medical University Beijing An Zhen Hospital
| | | | - Wenhua Zhao
- Chinese Center for Disease Control and Prevention
| | - Shiqi Zhen
- Jiangsu Provincial Center for Disease Control and Prevention
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- Chinese Center for Disease Control and Prevention
| | - Dan Zhu
- Inner Mongolia Medical University
| | - Marie Zins
- Institut National de la Santé et de la Recherche Médicale
- Paris University
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X, Yiallouros PK, Yoosefi M, Yoshihara A, You QS, You SL, Younger-Coleman NO, Yusof SM, Yusoff AF, Zaccagni L, Zafiropulos V, Zainuddin AA, Zakavi SR, Zamani F, Zambon S, Zampelas A, Zamrazilová H, Zapata ME, Zargar AH, Zaw KK, Zdrojewski T, Zeljkovic Vrkic T, Zeng Y, Zhang L, Zhang ZY, Zhao D, Zhao MH, Zhao W, Zhen S, Zheng W, Zheng Y, Zholdin B, Zhou M, Zhu D, Zocalo Y, Zuñiga Cisneros J, Zuziak M, Ezzati M. Height and body-mass index trajectories of school-aged children and adolescents from 1985 to 2019 in 200 countries and territories: a pooled analysis of 2181 population-based studies with 65 million participants. Lancet 2020; 396:1511-1524. [PMID: 33160572 PMCID: PMC7658740 DOI: 10.1016/s0140-6736(20)31859-6] [Citation(s) in RCA: 171] [Impact Index Per Article: 42.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 08/03/2020] [Accepted: 08/19/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Comparable global data on health and nutrition of school-aged children and adolescents are scarce. We aimed to estimate age trajectories and time trends in mean height and mean body-mass index (BMI), which measures weight gain beyond what is expected from height gain, for school-aged children and adolescents. METHODS For this pooled analysis, we used a database of cardiometabolic risk factors collated by the Non-Communicable Disease Risk Factor Collaboration. We applied a Bayesian hierarchical model to estimate trends from 1985 to 2019 in mean height and mean BMI in 1-year age groups for ages 5-19 years. The model allowed for non-linear changes over time in mean height and mean BMI and for non-linear changes with age of children and adolescents, including periods of rapid growth during adolescence. FINDINGS We pooled data from 2181 population-based studies, with measurements of height and weight in 65 million participants in 200 countries and territories. In 2019, we estimated a difference of 20 cm or higher in mean height of 19-year-old adolescents between countries with the tallest populations (the Netherlands, Montenegro, Estonia, and Bosnia and Herzegovina for boys; and the Netherlands, Montenegro, Denmark, and Iceland for girls) and those with the shortest populations (Timor-Leste, Laos, Solomon Islands, and Papua New Guinea for boys; and Guatemala, Bangladesh, Nepal, and Timor-Leste for girls). In the same year, the difference between the highest mean BMI (in Pacific island countries, Kuwait, Bahrain, The Bahamas, Chile, the USA, and New Zealand for both boys and girls and in South Africa for girls) and lowest mean BMI (in India, Bangladesh, Timor-Leste, Ethiopia, and Chad for boys and girls; and in Japan and Romania for girls) was approximately 9-10 kg/m2. In some countries, children aged 5 years started with healthier height or BMI than the global median and, in some cases, as healthy as the best performing countries, but they became progressively less healthy compared with their comparators as they grew older by not growing as tall (eg, boys in Austria and Barbados, and girls in Belgium and Puerto Rico) or gaining too much weight for their height (eg, girls and boys in Kuwait, Bahrain, Fiji, Jamaica, and Mexico; and girls in South Africa and New Zealand). In other countries, growing children overtook the height of their comparators (eg, Latvia, Czech Republic, Morocco, and Iran) or curbed their weight gain (eg, Italy, France, and Croatia) in late childhood and adolescence. When changes in both height and BMI were considered, girls in South Korea, Vietnam, Saudi Arabia, Turkey, and some central Asian countries (eg, Armenia and Azerbaijan), and boys in central and western Europe (eg, Portugal, Denmark, Poland, and Montenegro) had the healthiest changes in anthropometric status over the past 3·5 decades because, compared with children and adolescents in other countries, they had a much larger gain in height than they did in BMI. The unhealthiest changes-gaining too little height, too much weight for their height compared with children in other countries, or both-occurred in many countries in sub-Saharan Africa, New Zealand, and the USA for boys and girls; in Malaysia and some Pacific island nations for boys; and in Mexico for girls. INTERPRETATION The height and BMI trajectories over age and time of school-aged children and adolescents are highly variable across countries, which indicates heterogeneous nutritional quality and lifelong health advantages and risks. FUNDING Wellcome Trust, AstraZeneca Young Health Programme, EU.
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Santos MC, Assunção R, Matias F, Castanheira I, Rito A, Loureiro I. Baby foods available in the Portuguese marketplace and the application of nutrient profile models. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
An investment in nutrition at the earliest possible stage, providing appropriate complementary feeding, is critical to ensure proper growth and to prevent noncommunicable diseases (NCDs). Food and drinks high in fats, free sugars and salt are being marketed for consumption by young children and represent particular concern.
Aim
This study aims to determine the compliance of complementary foods (CACFs) for infants and young children sold in the Portuguese marketplace according to WHO draft Nutrient Profile model (NPM) for infants and young children between 6 and 36 months (1).
Methods
A sample of 128 CACFs was collected. Using nutritional food label information, products were divided into four food categories: dry, powdered and instant cereals; dry finger foods and snacks; meals with chunky pieces; and soft-wet spoonable, ready-to-eat foods. Packaging information was used to determine sodium, fat and sugar content per 100 g and percentage energy from total sugar by food category.
Results
Twenty-eight products (22%) comply with all the criteria established in the NPM. All the evaluated dry, powdered, and instant cereals, dry finger foods and snacks and meals with chunky pieces (n = 55) comply with recommendations proposed for total fat (≤4.5 g/100 kcal). Analysis of energy contribution from total sugars reveals 9 % (n = 5) of dry finger foods and snacks comply with the proposed criteria < 15% total energy from total sugars. The 73 soft-wet spoonable, ready-to-eat foods assessed, 74 % (n = 54) comply with the sodium thresholds of 50 mg/100 kcal, 64 % (n = 47) had a content ≥ 60 Kcal/100 g and 74 % (n = 54) contained over 20% of energy derived from sugar.
Conclusions
CACFs available in the Portuguese marketplace are characterised by products with high proportion of calories derived from sugar, promoting an environment that encourages development of sweet-taste preferences and adverse health outcomes resultant from the overconsumption of sugar in early life.
Key messages
There is an urgent need for updated regulations to support and guide product reformulation. A nutrient profile model for CACFs will establishes compositional thresholds and provides guidance on product-labelling and promotions.
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Affiliation(s)
- M Coelho Santos
- Food and Nutrition Department, National Health Institute Dr Ricardo Jorge, Lisbon, Portugal
- National School of Public Health, NOVA University, Lisbon, Portugal
| | - R Assunção
- Food and Nutrition Department, National Health Institute Dr Ricardo Jorge, Lisbon, Portugal
- CESAM-Centre for Environmental and Marine Studies, University of Aveiro, Aveiro, Portugal
| | - F Matias
- Food and Nutrition Department, National Health Institute Dr Ricardo Jorge, Lisbon, Portugal
| | - I Castanheira
- Food and Nutrition Department, National Health Institute Dr Ricardo Jorge, Lisbon, Portugal
| | - A Rito
- Food and Nutrition Department, National Health Institute Dr Ricardo Jorge, Lisbon, Portugal
| | - I Loureiro
- National School of Public Health, NOVA University, Lisbon, Portugal
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Goiana-da-Silva F, Severo M, Cruz e Silva D, Gregório MJ, Allen LN, Muc M, Morais Nunes A, Torres D, Miraldo M, Ashrafian H, Rito A, Wickramasinghe K, Breda J, Darzi A, Araújo F, Lopes C. Projected impact of the Portuguese sugar-sweetened beverage tax on obesity incidence across different age groups: A modelling study. PLoS Med 2020; 17:e1003036. [PMID: 32163412 PMCID: PMC7067376 DOI: 10.1371/journal.pmed.1003036] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 02/10/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Excessive consumption of sugar has a well-established link with obesity. Preliminary results show that a tax levied on sugar-sweetened beverages (SSBs) by the Portuguese government in 2017 led to a drop in sales and reformulation of these products. This study models the impact the market changes triggered by the tax levied on SSBs had on obesity incidence across various age groups in Portugal. METHODS AND FINDINGS We performed a national market analysis and population-wide modelling study using market data for the years 2014-2018 from the Portuguese Association of Non-Alcoholic Drinks (GlobalData and Nielsen Consumer Panel), dietary data from a national survey (IAN-AF 2015-2016), and obesity incidence data from several cohort studies. Dietary energy density from SSBs was calculated by dividing the energy content (kcal/gram) of all SSBs by the total food consumption (in grams). We used the potential impact fraction (PIF) equation to model the projected impact of the tax-triggered change in sugar consumption on obesity incidence, through both volume reduction and reformulation. Results showed a reduction of 6.6 million litres of SSBs sold per year. Product reformulation led to a decrease in the average energy density of SSBs by 3.1 kcal/100 ml. This is estimated to have prevented around 40-78 cases of obesity per year between 2016 and 2018, with the biggest projected impact observed in adolescents 10 to <18 years old. The model shows that the implementation of this tax allowed for a 4 to 8 times larger projected impact against obesity than would be achieved though reformulation alone. The main limitation of this study is that the model we used includes data from various sources, which can result in biases-despite our efforts to mitigate them-related to the methodological differences between these sources. CONCLUSIONS The tax triggered both a reduction in demand and product reformulation. These, together, can reduce obesity levels among frequent consumers of SSBs. Such taxation is an effective population-wide intervention. Reformulation alone, without the decrease in sales, would have had a far smaller effect on obesity incidence in the Portuguese population.
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Affiliation(s)
- Francisco Goiana-da-Silva
- Centre for Health Policy, Institute of Global Health Innovation, Imperial College London, London, United Kingdom
| | - Milton Severo
- Department of Public Health and Forensic Sciences and Medical Education, Faculty of Medicine, University of Porto, Porto, Portugal
- Epidemiology Research Unit, Institute of Public Health, University of Porto, Porto, Portugal
| | - David Cruz e Silva
- Centre for Innovation, Technology and Policy Research, University of Lisbon, Lisbon, Portugal
| | - Maria João Gregório
- Directorate General of Health, Lisbon, Portugal
- Faculty of Nutrition and Food Sciences, University of Porto, Porto, Portugal
| | - Luke N. Allen
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, England
| | - Magdalena Muc
- Department of Psychological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Alexandre Morais Nunes
- Centre for Public Administration and Public Policies, Institute of Social and Political Sciences, University of Lisbon, Lisbon, Portugal
| | - Duarte Torres
- Epidemiology Research Unit, Institute of Public Health, University of Porto, Porto, Portugal
- Faculty of Nutrition and Food Sciences, University of Porto, Porto, Portugal
| | - Marisa Miraldo
- Department of Economics and Public Policy, Imperial College Business School, London, United Kingdom
- Centre for Health Economics and Policy Innovation, Imperial College Business School, London, United Kingdom
| | - Hutan Ashrafian
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Ana Rito
- WHO Collaborating Centre for Nutrition and Childhood Obesity, National Institute of Health (INSA), Lisbon, Portugal
| | - Kremlin Wickramasinghe
- WHO European Office for the Prevention and Control of Noncommunicable Diseases, WHO Regional Office for Europe, Moscow, Russian Federation
| | - João Breda
- WHO European Office for the Prevention and Control of Noncommunicable Diseases, WHO Regional Office for Europe, Moscow, Russian Federation
| | - Ara Darzi
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Fernando Araújo
- University Hospital of São João, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Carla Lopes
- Department of Public Health and Forensic Sciences and Medical Education, Faculty of Medicine, University of Porto, Porto, Portugal
- Epidemiology Research Unit, Institute of Public Health, University of Porto, Porto, Portugal
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Goiana-da-Silva F, Cruz-E-Silva D, Allen L, Nunes AM, Calhau C, Rito A, Bento A, Miraldo M, Darzi A. Portugal's voluntary food reformulation agreement and the WHO reformulation targets. J Glob Health 2019; 9:020315. [PMID: 31656602 PMCID: PMC6790236 DOI: 10.7189/jogh.09.020315] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Francisco Goiana-da-Silva
- Centre for Health Policy, Institute of Global Health Innovation, Imperial College London, London, United Kingdom.,Faculdade de Ciências da Saúde, Universidade da Beira Interior, Covilhã, Portugal
| | - David Cruz-E-Silva
- Center for Innovation, Technology and Policy Research, IN+, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
| | - Luke Allen
- Nuffield Department of Primary Care Health Sciences, University of Oxford, United Kingdom
| | - Alexandre Morais Nunes
- Centre for Public Administration and Public Policies, Institute of Social and Political Sciences, University of Lisbon, Lisbon, Portugal
| | - Conceição Calhau
- Nutrition and Metabolism, NOVA Medical School, Faculty of Medical Sciences, NOVA University of Lisbon, Lisbon, Portugal.,Center for Health Technology Services Research (CINTESIS), Porto, Portugal
| | - Ana Rito
- INSA, National Institute of Health, Lisbon, Portugal
| | | | - Marisa Miraldo
- Department of Management & Centre for Health Economics & Policy Innovation (CHEPI), Imperial College Business School, London, United Kingdom
| | - Ara Darzi
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom
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Goiana-da-Silva F, Cruz-E-Silva D, Gregório MJ, Nunes AM, Calhau C, Hercberg S, Rito A, Bento A, Cruz D, Almeida F, Darzi A, Araújo F. Nutri-Score: A Public Health Tool to Improve Eating Habits in Portugal. ACTA MEDICA PORT 2019; 32:175-178. [PMID: 30946786 DOI: 10.20344/amp.11627] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 02/04/2019] [Indexed: 11/20/2022]
Affiliation(s)
- Francisco Goiana-da-Silva
- Centre for Health Policy. Institute of Global Health Innovation. Imperial College London. London. United Kingdom; Faculdade de Ciências da Saúde. Universidade da Beira Interior. Covilhã. Portugal
| | - David Cruz-E-Silva
- Center for Innovation, Technology and Policy Research, IN+. Instituto Superior Técnico. Universidade de Lisboa. Lisboa. Portugal
| | - Maria João Gregório
- Health Directorate-General. Lisboa. Faculty of Nutrition and Food Sciences. University of Porto. Porto. EpiDoC Unit. Chronic Diseases Research Center (CEDOC). NOVA Medical School. Lisboa. Portugal
| | - Alexandre Morais Nunes
- Centro de Administração e Políticas Públicas. Instituto Superior de Ciências Sociais e Políticas. Universidade de Lisboa. Lisboa. Portugal
| | - Conceição Calhau
- Department of Nutrition and Metabolism. NOVA Medical School. Lisboa. Center for Health Technology Services Research (CINTESIS). Porto. Portugal
| | - Serge Hercberg
- Equipe de Recherche en Epidémiologie Nutritionnelle (EREN). Inserm, Inra, Cnam. Université Paris 13. Paris. Département de Santé Publique. Hôpital Avicenne (AP-HP). Bobigny. França
| | - Ana Rito
- Instituto Nacional de Saúde Doutor Ricardo Jorge. National Institute of Health. Lisboa. Portugal
| | | | - Diogo Cruz
- Health Directorate-General. Lisboa. Portugal
| | - Fernando Almeida
- Instituto Nacional de Saúde Doutor Ricardo Jorge. National Institute of Health. Lisboa. Portugal
| | - Ara Darzi
- Department of Surgery and Cancer. Faculty of Medicine. Imperial College London. London. Reino Unido
| | - Fernando Araújo
- Faculty of Medicine. Porto University. Porto. Serviço de Imuno-hemoterapia. Centro Hospitalar Universitário São João. Porto. Portugal
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Sandjaja, Sans S, Marina LS, Santos DA, Santos IS, Santos O, dos Santos RN, Santos R, Saramies JL, Sardinha LB, Sarrafzadegan N, Saum KU, Savva S, Savy M, Scazufca M, Rosario AS, Schargrodsky H, Schienkiewitz A, Schipf S, Schmidt CO, Schmidt IM, Schultsz C, Schutte AE, Sein AA, Sen A, Senbanjo IO, Sepanlou SG, Serra-Majem L, Shalnova SA, Sharma SK, Shaw JE, Shibuya K, Shin DW, Shin Y, Shiri R, Siani A, Siantar R, Sibai AM, Silva AM, Silva DAS, Simon M, Simons J, Simons LA, Sjöberg A, Sjöström M, Skovbjerg S, Slowikowska-Hilczer J, Slusarczyk P, Smeeth L, Smith MC, Snijder MB, So HK, Sobngwi E, Söderberg S, Soekatri MYE, Solfrizzi V, Sonestedt E, Song Y, Sørensen TIA, Soric M, Jérome CS, Soumare A, Spinelli A, Spiroski I, Staessen JA, Stamm H, Starc G, Stathopoulou MG, Staub K, Stavreski B, Steene-Johannessen J, Stehle P, Stein AD, Stergiou GS, Stessman J, Stieber J, Stöckl D, Stocks T, Stokwiszewski J, Stratton G, Stronks K, Strufaldi MW, Suárez-Medina R, Sun CA, Sundström J, Sung YT, Sunyer J, Suriyawongpaisal P, Swinburn BA, Sy RG, Szponar L, Tai ES, Tammesoo ML, Tamosiunas A, Tan EJ, Tang X, Tanser F, Tao Y, Tarawneh MR, Tarp J, Tarqui-Mamani CB, Tautu OF, Braunerová RT, Taylor A, Tchibindat F, Theobald H, Theodoridis X, Thijs L, Thuesen BH, Tjonneland A, Tolonen HK, Tolstrup JS, Topbas M, Topór-Madry R, Tormo MJ, Tornaritis MJ, Torrent M, Toselli S, Traissac P, Trichopoulos D, Trichopoulou A, Trinh OTH, Trivedi A, Tshepo L, Tsigga M, Tsugane S, Tulloch-Reid MK, Tullu F, Tuomainen TP, Tuomilehto J, Turley ML, Tynelius P, Tzotzas T, Tzourio C, Ueda P, Ugel EE, Ukoli FAM, Ulmer H, Unal B, Uusitalo HMT, Valdivia G, Vale S, Valvi D, van der Schouw YT, Van Herck K, Van Minh H, van Rossem L, Van Schoor NM, van Valkengoed IGM, Vanderschueren D, Vanuzzo D, Vatten L, Vega T, Veidebaum T, Velasquez-Melendez G, Velika B, Veronesi G, Verschuren WMM, Victora CG, Viegi G, Viet L, Viikari-Juntura E, Vineis P, Vioque J, Virtanen JK, Visvikis-Siest S, Viswanathan B, Vlasoff T, Vollenweider P, Völzke H, Voutilainen S, Vrijheid M, Wade AN, Wagner A, Waldhör T, Walton J, Bebakar WMW, Mohamud WNW, Wanderley RS, Wang MD, Wang Q, Wang YX, Wang YW, Wannamethee SG, Wareham N, Weber A, Wedderkopp N, Weerasekera D, Whincup PH, Widhalm K, Widyahening IS, Wiecek A, Wijga AH, Wilks RJ, Willeit J, Willeit P, Wilsgaard T, Wojtyniak B, Wong-McClure RA, Wong JYY, Wong JE, Wong TY, Woo J, Woodward M, Wu FC, Wu J, Wu S, Xu H, Xu L, Yamborisut U, Yan W, Yang X, Yardim N, Ye X, Yiallouros PK, Yngve A, Yoshihara A, You QS, Younger-Coleman NO, Yusoff F, Yusoff MFM, Zaccagni L, Zafiropulos V, Zainuddin AA, Zambon S, Zampelas A, Zamrazilová H, Zdrojewski T, Zeng Y, Zhao D, Zhao W, Zheng W, Zheng Y, Zholdin B, Zhou M, Zhu D, Zhussupov B, Zimmermann E, Cisneros JZ, Bentham J, Di Cesare M, Bilano V, Bixby H, Zhou B, Stevens GA, Riley LM, Taddei C, Hajifathalian K, Lu Y, Savin S, Cowan MJ, Paciorek CJ, Chirita-Emandi A, Hayes AJ, Katz J, Kelishadi R, Kengne AP, Khang YH, Laxmaiah A, Li Y, Ma J, Miranda JJ, Mostafa A, Neovius M, Padez C, Rampal L, Zhu A, Bennett JE, Danaei G, Bhutta ZA, Ezzati M. Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128·9 million children, adolescents, and adults. Lancet 2017; 390:2627-2642. [PMID: 29029897 PMCID: PMC5735219 DOI: 10.1016/s0140-6736(17)32129-3] [Citation(s) in RCA: 3623] [Impact Index Per Article: 517.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 07/12/2017] [Accepted: 07/19/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Underweight, overweight, and obesity in childhood and adolescence are associated with adverse health consequences throughout the life-course. Our aim was to estimate worldwide trends in mean body-mass index (BMI) and a comprehensive set of BMI categories that cover underweight to obesity in children and adolescents, and to compare trends with those of adults. METHODS We pooled 2416 population-based studies with measurements of height and weight on 128·9 million participants aged 5 years and older, including 31·5 million aged 5-19 years. We used a Bayesian hierarchical model to estimate trends from 1975 to 2016 in 200 countries for mean BMI and for prevalence of BMI in the following categories for children and adolescents aged 5-19 years: more than 2 SD below the median of the WHO growth reference for children and adolescents (referred to as moderate and severe underweight hereafter), 2 SD to more than 1 SD below the median (mild underweight), 1 SD below the median to 1 SD above the median (healthy weight), more than 1 SD to 2 SD above the median (overweight but not obese), and more than 2 SD above the median (obesity). FINDINGS Regional change in age-standardised mean BMI in girls from 1975 to 2016 ranged from virtually no change (-0·01 kg/m2 per decade; 95% credible interval -0·42 to 0·39, posterior probability [PP] of the observed decrease being a true decrease=0·5098) in eastern Europe to an increase of 1·00 kg/m2 per decade (0·69-1·35, PP>0·9999) in central Latin America and an increase of 0·95 kg/m2 per decade (0·64-1·25, PP>0·9999) in Polynesia and Micronesia. The range for boys was from a non-significant increase of 0·09 kg/m2 per decade (-0·33 to 0·49, PP=0·6926) in eastern Europe to an increase of 0·77 kg/m2 per decade (0·50-1·06, PP>0·9999) in Polynesia and Micronesia. Trends in mean BMI have recently flattened in northwestern Europe and the high-income English-speaking and Asia-Pacific regions for both sexes, southwestern Europe for boys, and central and Andean Latin America for girls. By contrast, the rise in BMI has accelerated in east and south Asia for both sexes, and southeast Asia for boys. Global age-standardised prevalence of obesity increased from 0·7% (0·4-1·2) in 1975 to 5·6% (4·8-6·5) in 2016 in girls, and from 0·9% (0·5-1·3) in 1975 to 7·8% (6·7-9·1) in 2016 in boys; the prevalence of moderate and severe underweight decreased from 9·2% (6·0-12·9) in 1975 to 8·4% (6·8-10·1) in 2016 in girls and from 14·8% (10·4-19·5) in 1975 to 12·4% (10·3-14·5) in 2016 in boys. Prevalence of moderate and severe underweight was highest in India, at 22·7% (16·7-29·6) among girls and 30·7% (23·5-38·0) among boys. Prevalence of obesity was more than 30% in girls in Nauru, the Cook Islands, and Palau; and boys in the Cook Islands, Nauru, Palau, Niue, and American Samoa in 2016. Prevalence of obesity was about 20% or more in several countries in Polynesia and Micronesia, the Middle East and north Africa, the Caribbean, and the USA. In 2016, 75 (44-117) million girls and 117 (70-178) million boys worldwide were moderately or severely underweight. In the same year, 50 (24-89) million girls and 74 (39-125) million boys worldwide were obese. INTERPRETATION The rising trends in children's and adolescents' BMI have plateaued in many high-income countries, albeit at high levels, but have accelerated in parts of Asia, with trends no longer correlated with those of adults. FUNDING Wellcome Trust, AstraZeneca Young Health Programme.
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Carvalho M, Rito A, Pereira Miguel J. SUN-PP203: PAC24 - The Portuguese Self-Administered Computerised 24-Hour Dietary Recall. Clin Nutr 2015. [DOI: 10.1016/s0261-5614(15)30354-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Carvalho M, Baranowski T, Foster E, Santos O, Cardoso B, Rito A, Pereira Miguel J. Validation of the Portuguese self-administered computerised 24-hour dietary recall among second-, third- and fourth-grade children. J Hum Nutr Diet 2014; 28:666-74. [DOI: 10.1111/jhn.12280] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- M.A. Carvalho
- Institute of Preventive Medicine and Public Health; Faculty of Medicine; University of Lisbon; Lisboa Portugal
| | - T. Baranowski
- USDA/ARS Children's Nutrition Research Center; Baylor College of Medicine; Houston TX USA
| | - E. Foster
- Human Nutrition Research Centre; Institute of Health and Society; University of Newcastle; Newcastle upon Tyne UK
| | - O. Santos
- Institute of Preventive Medicine and Public Health; Faculty of Medicine; University of Lisbon; Lisboa Portugal
| | - B. Cardoso
- Center for Informatics and Information Technologies; Faculty of Sciences and Technology; New University of Lisbon; Lisboa Portugal
| | - A. Rito
- National Institute of Health Doutor Ricardo Jorge; Lisboa Portugal
| | - J. Pereira Miguel
- Institute of Preventive Medicine and Public Health; Faculty of Medicine; University of Lisbon; Lisboa Portugal
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Divajeva D, Marsh T, Logstrup S, Kestens M, Vemer P, Kriaucioniene V, Peresson S, O’Kelly S, Rito A, Webber L. Economics of chronic diseases protocol: cost-effectiveness modelling and the future burden of non-communicable disease in Europe. BMC Public Health 2014; 14:456. [PMID: 24886110 PMCID: PMC4047783 DOI: 10.1186/1471-2458-14-456] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 04/17/2014] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND The majority of chronic disease is caused by risk factors which are mostly preventable. Effective interventions to reduce these risks are known and proven to be applicable to a variety of settings. Chronic disease is generally developed long before the fatal outcome, meaning that a lot of people spend a number of years in poor health. Effective prevention measures can prolong lives of individuals and significantly improve their quality of life. However, the methods to measure cost-effectiveness are a subject to much debate. The Economics of Chronic Diseases project aims to establish the best possible methods of measuring cost-effectiveness as well as develop micro-simulation models apt at projecting future burden of chronic diseases, their costs and potential savings after implementation of cost-effective interventions. METHOD This research project will involve eight European countries: Bulgaria, Finland, Greece, Lithuania, The Netherlands, Poland, Portugal and the United Kingdom (UK). A literature review will be conducted to identify scientific articles which critically review the methods of cost-effectiveness. Contact will be made health economists to inform and enrich this review. This evidence will be used as a springboard for discussion at a meeting with key European stakeholders and experts with the aim of reaching a consensus on recommendations for cost-effectiveness methodology. Epidemiological data for coronary heart disease, chronic kidney disease, type 2 diabetes and chronic obstructive pulmonary disease will be collected along with data on time trends in three major risk factors related to these diseases, specifically tobacco consumption, blood pressure and body mass index. Economic and epidemiological micro-simulation models will be developed to asses the future distributions of risks, disease outcomes, healthcare costs and the cost-effectiveness of interventions to reduce the burden of chronic diseases in Europe. DISCUSSION This work will help to establish the best methods of measuring cost-effectiveness of health interventions as well as test a variety of scenarios to reduce the risk factors associated with selected chronic diseases. The modelling projections could be used to inform decisions and policies that will implement the best course of action to curb the rising incidence of chronic diseases.
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Affiliation(s)
- Diana Divajeva
- UK Health Forum, Fleetbank House, 2-6 Salisbury Square, EC4Y 8JX London, UK
| | - Tim Marsh
- UK Health Forum, Fleetbank House, 2-6 Salisbury Square, EC4Y 8JX London, UK
| | | | - Marleen Kestens
- European Heart Network, Rue Montoyer 31, 1000 Brussels, Belgium
| | - Pepijn Vemer
- PharmacoEpidemiology & PharmacoEconomics (PE2), University of Groningen, Groningen, the Netherlands
- Department of Epidemiology, University Medical Centre Groningen, Groningen, the Netherlands
| | - Vilma Kriaucioniene
- Lithuanian University of Health Sciences, A. Mickevičiaus g. 9, LT 44307 Kaunas, Lithuania
| | - Sophie Peresson
- International Diabetes Federation European region (IDF Europe), 166 Chaussee de La Hulpe, B-1170 Brussels, Belgium
| | - Sophie O’Kelly
- European Society of Cardiology, 2035 Route des Colles - Les Templiers, 06903 Sophia Antipolis, France
| | - Ana Rito
- National Institute of Health Doutor Ricardo Jorge, I.P. Av. Padre Cruz, 1649-016 Lisbon, Portugal
| | - Laura Webber
- UK Health Forum, Fleetbank House, 2-6 Salisbury Square, EC4Y 8JX London, UK
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Rito A, Wijnhoven TMA, Rutter H, Carvalho MA, Paixão E, Ramos C, Claudio D, Espanca R, Sancho T, Cerqueira Z, Carvalho R, Faria C, Feliciano E, Breda J. Prevalence of obesity among Portuguese children (6-8 years old) using three definition criteria: COSI Portugal, 2008. Pediatr Obes 2012; 7:413-22. [PMID: 22899658 DOI: 10.1111/j.2047-6310.2012.00068.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2011] [Revised: 04/17/2012] [Accepted: 04/19/2012] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Previous studies place Portugal among the five countries with the highest prevalence of childhood obesity in Europe. This paper describes the prevalence of thinness, overweight and obesity in Portuguese children of 6-8 years of age, based on the first data collection from Childhood Obesity Surveillance Initiative Portugal, which took place during the 2007/2008 school year. METHODS This study uses a semi-longitudinal design with repeated cross-sectional national representative samples. Specific prevalence of overweight (including obesity) and obesity was determined using three different diagnostic criteria. Across the seven geographic regions, 3765 children were enrolled from 181 schools; 50.3% of participants were males. RESULTS Using the International Obesity Task Force reference, the prevalence of thinness, overweight and obesity were 4.8%, 28.1% and 8.9%, respectively; using the Center for Disease Control and Prevention reference they were 2.1%, 32.2% and 14.6%, respectively; and according to the World Health Organization reference, they were 1.0%, 37.9% and 15.3%, respectively. Univariate analysis showed a higher risk of obesity in older children, in boys and in the Azores region. The islands of Madeira and the Azores were the regions with the highest prevalence of overweight at 39.4% and 46.6%, respectively, and Algarve was the one with the lowest (21.4%). CONCLUSION These findings demonstrate the need for urgent action in Portugal and provide policy-makers with comprehensive and detailed information to assist with this.
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Affiliation(s)
- A Rito
- National Institute of Health Dr Ricardo Jorge, Lisbon, Portugal.
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